In Review: The Governor’s Office proposed a new amendment to HB 5395, a bill that bans step therapy. The amendment is confusing but does not seem to address the industry’s concerns. The Legislative Audit Commission, comprised of a bipartisan group of legislators, held a hearing last week on the Auditor General’s performance audit of the HFS’ Medicaid pharmacy benefits program. HFS testified to how they will comply with audit findings. They explained that within the Illinois managed care program, the managed care organizations (MCO) are paid monthly capitation rates per member, from which the MCOs handle pharmacy benefits through their own contracts with pharmacy benefit managers (PBMs). All monies paid to PBMs are counted towards the MCOs’ medical loss ratio.

Up Next: There is a subject matter hearing scheduled for Tuesday, May 7, in Springfield to discuss PBMs and likely HB 4548. Leader Manley plans for the hearing to follow the same format at the last hearing providing a point/counter point narrative. PCMA, along with Cigna and Prime Therapeutics, plan to testify.

If you have any questions, please contact Melodie Shrader at mshrader@pcmanet.org.